Jagdeep Singh Pruthi, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME104073 Issued in FL

Practice address

25103 Hwy 27
Lake Wales, FL 33859-6843

Phone

(863) 734-0344

Fax

(877) 658-8666

NPI assigned

Mar 31, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/AGCACD/Endpoint/AGCACD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sunrise Pediatrics LLC

  • Pediatrics Physician
  • Lake Wales, FL
  • NPI 1891939989
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765152000000",
    "number": "1609018183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25103 HWY 27",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338596843",
            "telephone_number": "863-734-0344",
            "fax_number": "877-658-8666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25103 HWY 27",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338596843",
            "telephone_number": "863-734-0344",
            "fax_number": "877-658-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUTHI",
        "first_name": "JAGDEEP",
        "middle_name": "SINGH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-31",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME104073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Polk Rehabilitation Inc
• Eliany Ponce Benitez
• Carmen Del Rosario Ponce de Leon Rodriguez
• Matthew Isaac Povilaitis
• Preserva Therapy Group Inc
• Publix Super Markets Inc
• Publix Super Markets, Inc.
• Purposeful Healing LLC
• Jack Pyle
• Qiv Tech Academy, Inc

• Pediatrics Physician in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.